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Liberating Health Care Professionals by Lorne Kashin

Eye Care professionals continue to spar with one another over scope of practise issues on a province-by-province basis.  Some progress has been made in some provinces but unless and until the Federal government brokers an agreement amongst provincial Premiers to force the issue, health care professionals in general – and health care professionals in particular will continue to be stalled in endless turf wars and political manoeuvring.  Opticians will not be able to apply extended knowledge and innovative practice models to better serve their patients.

As Linda Silas and Steven Lewis point out in their Globe and Mail article of September 26, 2012-10-12, “Why Medicare Needs Ottawa”

“Canada needs a new Health Accord to liberate health-care talent”  “(due to) rigid workplace cultures, many health-care professionals are unable to use all of their knowledge and skills in the workplace.”


“…too many health-care professionals are working below their capabilities.”

This is never more evident than in the 5 or 6 years Ontario vision care professionals have been commenting on the proposed optometric Conflict of Interest (COI) regulation.  As is the protocol, the College of Optometrists of Ontario published the draft of their revised COI with an invitation to concerned professional groups to comment.  The OOA submitted its commentary in 2005.  In addition there has been ongoing discussion between our two groups to achieve a practice model for optometrists that allows for true collaboration between opticians and optometrists.

Although some changes have been made to the draft to reflect an easier and more co-operative relationship, the current edition of the COI Regulation remains riddled with obscurities and phrases that are subject to vague or specific interpretation.  Interpretation of regulation always depends on the political will of the individuals in charge at any given moment.  Given the turf war mentality that has pervaded provincial optometrists for decades we suspect moving forward the regulation will have the most conservative application.

Insofar as scope of practice is concerned, Optometrists have steadfastly lobbied against Opticians gaining an increased scope of practice in spite of the success of existing models in Canada of optician-performed refracting.  HPRAC has twice recommended against this increase as have fifth column opticians splinter groups in Ontario who are content with allowing optometrists to be the gatekeepers to the vision care system.  The OOA doesn’t believe our profession can survive with this master/servant attitude.

We believe that Linda Silas and Steven Lewis are correct in postulating that

“A common approach to scope-of-practice reform will be a huge challenge under any circumstances, but close to impossible without Ottawa playing a major role.”

On the face of it provincial governments and provincial regulatory bodies have taken up the challenge to collaborate, investigate, participate and practice with a more enlightened approach to their colleagues with overlapping scopes of practice.  But in fact many pay only lip service to this mandate.

Let’s give our heads a shake here!  It took federal impetus for provinces to sign on to the Agreement on Internal Trade.  It took almost a decade for provincial opticians’ groups to get past provincial bigotry and consent to a Mutual Recognition Agreement (which eliminates the barriers to opticians relocating and becoming licensed in another province).  Sadly the federal government’s expectation of self-regulating bodies to abandon regulation that amounts to self-protection has not been realized.

As the Globe and Mail article reports:

“Either it will be dealt with nationally in a coordinated and evidence-based fashion, or it will evolve in fits and starts, with a modest advance here and a setback there, shaped by local politics, deal-making, and expediency.”

You can read the complete Globe and Mail article at


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